Which is the priority nursing diagnosis for a patient with shallow respirations following abdominal surgery?

Choice A rationale:

Echinacea: It has anti-inflammatory properties and is not typically associated with exacerbating rheumatoid arthritis symptoms. Studies have shown potential benefits in reducing inflammation, including evidence of possible effectiveness for osteoarthritis and rheumatoid arthritis. However, more research is needed to confirm its efficacy and safety in rheumatoid arthritis.

Choice B rationale:

Turmeric:

Curcumin, the active component of turmeric, has both anti-inflammatory and pro-inflammatory effects.

While it has potential benefits for some inflammatory conditions, it can also stimulate the immune system, which could worsen rheumatoid arthritis symptoms in certain individuals.

Studies have shown mixed results, with some indicating potential benefits and others suggesting a possible worsening of symptoms.

Due to this uncertainty, caution is advised, and patients with rheumatoid arthritis should consult with their healthcare providers before using turmeric supplements.

Choice C rationale:

Ginger: It has well-documented anti-inflammatory properties and is not known to exacerbate rheumatoid arthritis symptoms.

Studies have shown ginger to be potentially effective in reducing pain and inflammation in individuals with rheumatoid arthritis.

It is generally considered safe for use in this population.

Choice D rationale:

Valerian: It is a herb primarily used for its sedative and sleep-promoting effects.

It has not been shown to have any significant impact on inflammation or rheumatoid arthritis symptoms. There is no evidence to suggest that it would worsen the condition.

Choice A rationale:

While checking intravenous lines for patency and redness is important, it's not the most immediate priority in the post- anesthesia care unit (PACU). Ensuring airway patency and adequate oxygenation takes precedence over IV assessment. Issues with IV lines can usually be addressed quickly if they arise, whereas compromised airway or breathing can rapidly lead to life- threatening complications.

Choice B rationale:

Assessment of nasogastric tubes and bowel sounds is also important, but it's not as urgent as checking the airway and breathing. Bowel sounds may be absent immediately after surgery due to anesthesia and bowel manipulation, and their presence or absence doesn't necessarily indicate an immediate problem. Similarly, nasogastric tubes can be checked and adjusted as needed after ensuring the patient's airway and breathing are stable.

Choice D rationale:

Checking the Foley catheter and surgical fluid intake is essential for monitoring fluid balance and renal function, but it's not a priority over assessing airway, breathing, and circulation (ABCs). Fluid status can be assessed and managed after ensuring the patient's respiratory and circulatory systems are functioning adequately.

Choice C rationale:

Checking the airway, lung sounds, and pulse oximetry is the most critical assessment in the PACU because it ensures that the patient is breathing effectively and has adequate oxygen saturation. This assessment addresses the primary ABCs of patient care:

Airway: The nurse will assess for any obstructions or potential for obstruction, such as swelling, secretions, or the tongue blocking the airway. They will also ensure proper positioning of the head and neck to maintain airway patency.

Breathing: The nurse will listen to lung sounds to evaluate air entry and identify any signs of respiratory distress, such as wheezing, crackles, or decreased breath sounds. They will also monitor respiratory rate and effort.

Circulation: Pulse oximetry measures oxygen saturation in the blood, providing a quick and non-invasive assessment of oxygenation status. It's essential to ensure adequate oxygen delivery to tissues and organs.

By prioritizing the assessment of airway, lung sounds, and pulse oximetry, the nurse can quickly identify and intervene in any respiratory or oxygenation issues, preventing potentially life-threatening complications.